SHOULDER IMPAIRMENT OF

B. MULLINS · 2026 · Case ID: 26004128

DENIED

Summary

The Veteran, who served in the United States Army from May 1989 to May 1992 and July 1993 to December 1996, including service recognized by a Southwest Asia Service Medal, Kuwait Liberation Medal, National Defense Service Medal, and 3 Bronze Service Stars, appeals the denial of service connection for multiple conditions. The Veteran passed away in June 2022, and his surviving spouse has been substituted as the appellant. The case has been remanded multiple times for further development, most recently in September 2024, to secure complete military personnel and treatment records. The Board found the Regional Office substantially complied with these directives, making exhaustive attempts to locate records and requesting them from the Appellant when unavailable. The Veteran sought service connection for right and left shoulder disabilities, a cardiovascular disorder (heart palpitations, hypertensive heart disease), a liver condition (elevated liver enzymes, NAFLD), degenerative joint disease of the cervical spine, and obstructive sleep apnea (OSA). The Board denied all claims, finding that the competent evidence of record did not establish that any of these conditions were incurred in, aggravated by, or causally related to the Veteran's active duty military service. The Board cited the lack of nexus evidence as the primary reason for denial across all conditions.

Rationale

No evidence of in-service incurrence or aggravation; No nexus between claimed in-service injury and present disability

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

14-36 476

Full Decision Text

Citation Nr: 26004128
Decision Date: 04/03/26 Archive Date: 04/03/26

DOCKET NO. 14-36 476
DATE: April 3, 2026

ORDER

Entitlement to service connection for a right shoulder disability is denied.

Entitlement to service connection for a left shoulder disability is denied.

Entitlement to service connection for a cardiovascular disorder manifested by heart palpitations and hypertensive heart disease is denied.

Entitlement to service connection for a liver condition manifested by elevated liver enzymes and non-alcoholic fatty liver disease (NAFLD) is denied.

Entitlement to service connection for degenerative joint disease of the cervical spine is denied.

Entitlement to service connection for obstructive sleep apnea (OSA) is denied.

FINDINGS OF FACT

1. The competent evidence of record does not show that the Veteran's right shoulder disability was incurred in, aggravated by, or is otherwise causally related to the Veteran's active duty military service.

2. The competent evidence of record does not show that the Veteran's left shoulder disability was incurred in, aggravated by, or is otherwise causally related to the Veteran's active duty military service.

3. The competent evidence of record does not show that the Veteran's cardiovascular disorder manifested by heart palpitations and hypertensive heart disease was incurred in, aggravated by, or is otherwise causally related to the Veteran's active duty military service.

4. The competent evidence of record does not show that the Veteran's liver condition manifested by elevated liver enzymes and NAFLD was incurred in, aggravated by, or is otherwise causally related to the Veteran's active duty military service.

5. The competent evidence of record does not show that the Veteran's degenerative joint disease of the cervical spine was incurred in, aggravated by, or is otherwise causally related to the Veteran's active duty military service.

6. The competent evidence of record does not show that the Veteran's OSA was incurred in, aggravated by, or is otherwise causally related to the Veteran's active duty military service.

CONCLUSIONS OF LAW

1. The criteria for establishing entitlement to service connection for right shoulder disability have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303.

2. The criteria for establishing entitlement to service connection for a left shoulder disability have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303.

3. The criteria for establishing entitlement to service connection for a cardiovascular disorder manifested by heart palpitations and hypertensive heart disease have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309.

4. The criteria for establishing entitlement to service connection for a liver condition manifested by elevated liver enzymes and NAFLD have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303.

5. The criteria for establishing entitlement to service connection for degenerative joint disease of the cervical spine have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303.

6. The criteria for establishing entitlement to service connection for OSA have not been met. 38 U.S.C. §§ 1110, 1116, 5107; 38 C.F.R. §§ 3.102, 3.303.

REASONS AND BASES FOR FINDINGS AND CONCLUSIONS

The Veteran served on active duty in the United States Army from May 1989 to May 1992 and from July 1993 to December 1996. The Veteran is in receipt of a Southwest Asia Service Medal, the Kuwait Liberation Medal, the National Defense Service Medal, and 3 Bronze Service Stars.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a November 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

Unfortunately, the Veteran passed away in June 2022. The Appellant is his surviving spouse and has been properly substituted.

This claim has previously been remanded for further development in May 2018, July 2020, and September 2024. In the September 2024 remand directives, the RO was instructed to make an exhaustive attempt to secure the Veteran's complete military personnel
The Veteran is in receipt of a Southwest Asia Service Medal, the Kuwait Liberation Medal, the National Defense Service Medal, and 3 Bronze Service Stars.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a November 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO).

Unfortunately, the Veteran passed away in June 2022. The Appellant is his surviving spouse and has been properly substituted.

This claim has previously been remanded for further development in May 2018, July 2020, and September 2024. In the September 2024 remand directives, the RO was instructed to make an exhaustive attempt to secure the Veteran's complete military personnel and treatment records for all periods of active-duty in the Texas Army National Guard. If such records are unavailable, the RO was instructed to request the records from the Appellant. In the event the records could still not be located, the RO was to document that fact.

The Board finds that the RO has substantially complied with this remand directive. The file contains September, October, and December 2024 requests for information. Further, the Appellant was sent a February 2025 final request indicating that the RO could not locate the requested documents and requesting the Appellant to provide any records in her possession.

Service connection.

Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in the active military service or, if pre-existing such service, was aggravated thereby. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303 (a).

Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F. 3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table); 38 C.F.R. § 3.303.

Service connection may also be granted for any disease diagnosed after the military discharge, when all the evidence, including that pertinent to the period of military service, establishes that the disease was incurred during the active military service. 38 U.S.C. § 1113 (b); 38 C.F.R. § 3.303 (d).

Service connection may also be established on a secondary basis for a disability which is proximately due to, or aggravated by, a service-connected disease or injury. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.310. In order to prevail on the theory of secondary service connection, there must be evidence of a current disability; evidence of a service-connected disability; and evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998).

In determining whether service connection is warranted for a disability, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the Veteran prevailing in either event, or whether evidence persuasively weighs against the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded to the Veteran.

1. Entitlement to service connection for right shoulder disability is denied.

The Appellant contends that the Veteran's right shoulder condition and left shoulder condition are causally related to his active duty military service. Having carefully considered the evidence of record, and considering all relevant rules and regulations, the Board finds that service connection for either a right shoulder condition or a left shoulder condition is not warranted.

Initially, a March 2014 VA examiner diagnosed the Veteran with bilateral shoulder strains and bilateral degenerative changes of the acromioclavicular joints. Further, the Veteran submitted a July 2010 Statement in Support of Claim in which he alleged that his shoulder disabilities began while he participated in Operation Desert Storm. Considering this evidence in a light most favorable to the Veteran, the Board finds that the first two elements of service connection have been satisfied. The remaining issued to be decided is whether the Veteran's bilateral shoulder conditions were incurred in or
. Having carefully considered the evidence of record, and considering all relevant rules and regulations, the Board finds that service connection for either a right shoulder condition or a left shoulder condition is not warranted.

Initially, a March 2014 VA examiner diagnosed the Veteran with bilateral shoulder strains and bilateral degenerative changes of the acromioclavicular joints. Further, the Veteran submitted a July 2010 Statement in Support of Claim in which he alleged that his shoulder disabilities began while he participated in Operation Desert Storm. Considering this evidence in a light most favorable to the Veteran, the Board finds that the first two elements of service connection have been satisfied. The remaining issued to be decided is whether the Veteran's bilateral shoulder conditions were incurred in or are otherwise causally related to his military service.

The Veteran submitted a July 2010 Statement in Support of Claim. The Veteran stated that he developed bilateral shoulder problems while driving a tractor trailer in the desert while serving in Operation Desert Storm. The Veteran indicated that he did not report his symptoms at that time and he just "sucked it up".

The Veteran filed a VA Form 9 Notice of Disagreement in October 2014. On that form, the Veteran indicated that he believes that his shoulder disabilities are related to his military service and participation in Operation Desert Storm. The Veteran stated that he believes that he was poisoned by the Gulf War.

The Veteran was afforded a VA examination in March 2014. The examiner diagnosed the Veteran as suffering from bilateral shoulder strains and bilateral degenerative changes of the acromioclavicular joints. The physician ultimately opined that he could not relate the Veteran's current bilateral shoulder disabilities to his active duty military service without resorting to medical speculation. In his report, the examiner indicated that the Veteran's active duty treatment records could not be located.

The Veteran attended a VA examination in June 2019. The examiner diagnosed the Veteran as suffering from degenerative arthritis of the shoulders bilaterally. The examiner took a history of the Veteran's shoulder conditions beginning in-service while the Veteran was driving a truck without a trailer in the desert. The Veteran reported going on sick call for his neck and shoulders while stationed overseas on several occasions. The examiner concluded that it is less likely than not that the Veteran's bilateral shoulder conditions had an in-service onset or are otherwise related to the Veteran's military service to include service in the Persian Gulf. The examiner found no service treatment records or any other evidence documenting shoulder pain or symptoms in-service or immediately post service. The examiner found that first documented treatment for shoulder conditions occurred in 2014.

The Board finds that the June 2019 report has previously been determined to be inadequate for adjudication purposes by way of a July 2020 Board order. The June 2019 report was deemed inadequate because the report did not consider all lay evidence and all necessary treatment records were not available for review at the time of the June 2019 examination.

The Veteran was afforded a VA examination in April 2021. An addendum to this report was authored in September 2021. In the September 2021 report, the examiner ultimately concluded that it is less likely than not that the Veteran's bilateral shoulder strains and degenerative changes of the acromioclavicular joints arose in or were caused by the Veteran's military service.

The Board finds that the April 2021and September 2021reports have previously been determined to be inadequate for adjudication purposes by way of a September 2024 Board order. The above listed reports were deemed inadequate because the reports did not provide rationale in support of the conclusions.

The VA conducted a review of the evidence of record in December 2024. The examiner prepared separate reports for the left and right shoulder, although the findings were virtually identical. The examiner confirmed the diagnoses bilateral shoulder strains and bilateral degenerative joint disease of the acromioclavicular joints. The examiner ultimately opined that it is less likely than not the Veteran's shoulder conditions were incurred in or caused by the Veteran's military service. The examiner indicated that he did not find any complaints of, or treatment for, shoulder conditions in the Veteran's service treatment records or immediately post service. Accordingly, the examiner indicated that he could establish evidence of a chronic disability and he
did not provide rationale in support of the conclusions.

The VA conducted a review of the evidence of record in December 2024. The examiner prepared separate reports for the left and right shoulder, although the findings were virtually identical. The examiner confirmed the diagnoses bilateral shoulder strains and bilateral degenerative joint disease of the acromioclavicular joints. The examiner ultimately opined that it is less likely than not the Veteran's shoulder conditions were incurred in or caused by the Veteran's military service. The examiner indicated that he did not find any complaints of, or treatment for, shoulder conditions in the Veteran's service treatment records or immediately post service. Accordingly, the examiner indicated that he could establish evidence of a chronic disability and he could not relate the Veteran's shoulder conditions to his military service.

The Appellant has not provided a medical report or any other competent evidence indicating that the Veteran's bilateral shoulder conditions are related to his active duty military service. The Board acknowledges the Appellant's contentions, the numerous buddy statements filed in support of the Veteran, and the late Veteran's statements indicating that his bilateral shoulder conditions are related to his military service. The Board acknowledges that the Veteran was competent to report his symptoms and on matters of which he had personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, there is no evidence that the Veteran in this case was competent to provide a nexus opinion regarding this issue as this issue is medically complex and the record does not show that the Veteran had the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).

Considering the foregoing, the evidence persuasively weighs against the claim. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). The benefit of the doubt doctrine, see 38 U.S.C. § 5107 (b), is therefore not applicable to this claim. Accordingly, service connection for right shoulder condition and left shoulder condition are denied.

2. Entitlement to service connection for left shoulder disability is denied.

See 1 above.

3. Entitlement to service connection for a cardiovascular disorder manifested by heart palpitations and hypertensive heart disease is denied.

The Appellant contends that the Veteran's cardiovascular disorder manifested by heart palpitations and hypertensive disorder is causally related to his active duty military service. Having carefully considered the evidence of record, and considering all relevant rules and regulations, the Board finds that the Appellant's contention is not warranted.

Initially, a June 2019 VA examiner found that the Veteran had been diagnosed with hypertensive heart disease and ventricular premature beats. The Board acknowledges that hypertension may be presumed related to service as a chronic disease. 38 C.F.R. § 3.309(a). However, this presumption requires in-service manifestations either sufficient to identify the disease in-service, symptoms continuously since service, or manifestations to a compensable degree within one year of separation from service. 38 C.F.R. §§ 3.303(b), 3.307(a). The medical evidence of record does not support a finding that the Veteran's hypertensive heart disease/hypertension was present during or within one year of service separation. Rather, the Veteran's hypertension/hypertensive heart disease was not diagnosed until July 2010, approximately 14 years post service. Additionally, there is no evidence that the Veteran was exposed to herbicides in-service. Thus, presumptive service connection is not available for hypertensive heart disease/hypertension as a chronic disease.

Although there is no presumptive service connection for hypertensive heart disease/hypertension, the Veteran is not precluded from establishing service connection for a cardiovascular condition manifested by heart palpitations and hypertensive heart disease with proof of actual causation, that is, proof that the Veteran's heart condition is causally related to the Veteran's military service to include toxic exposures. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); 38 C.F.R. § 3.303 (d).

As stated above, a June 2019 VA examiner found that the Veteran had been diagnosed with a cardiovascular condition manifested by hypertensive heart disease and ventricular premature beats. Further, the Veteran submitted a July 2010 statement in support of his claim in which he alleged that his heart palpitations began when he participated in Operation Desert Storm. Considering this evidence in a light most favorable to the Veteran, the Board finds that the
Veteran's heart condition is causally related to the Veteran's military service to include toxic exposures. Combee v. Brown, 34 F.3d 1039, 1042 (Fed. Cir. 1994); 38 C.F.R. § 3.303 (d).

As stated above, a June 2019 VA examiner found that the Veteran had been diagnosed with a cardiovascular condition manifested by hypertensive heart disease and ventricular premature beats. Further, the Veteran submitted a July 2010 statement in support of his claim in which he alleged that his heart palpitations began when he participated in Operation Desert Storm. Considering this evidence in a light most favorable to the Veteran, the Board finds that the first two elements of service connection have been satisfied. The remaining issued to be decided is whether the Veteran's cardiovascular disorder manifested by heart palpitations and hypertensive heart disease was incurred in or is otherwise causally related to his military service.

The Veteran attended a VA examination in March 2014. The examiner found that the Veteran does not currently have, and has never had, a diagnosable heart condition. The examiner cited to diagnostic testing performed during a cardiac evaluation in 2010. The examiner indicated that comprehensive testing performed at that time showed no evidence of clinically significant heart disease.

The Veteran attended a VA examination in June 2019. The examiner indicated that the Veteran was diagnosed with hypertension/ hypertensive heart disease and ventricular premature beats (VPBs) in July 2010. The examiner ultimately opined that it is less likely than not that the Veteran's hypertensive heart disease was incurred in or caused by his military service. The examiner further opined that it is less likely than not that the Veteran's hypertension/hypertensive heart disease was caused by his toxic exposures incurred while serving in the Gulf War.

The Veteran was afforded a VA examination in April 2021. An addendum to the April 2021 report was authored in September 2021. Upon a review of the examination findings and the evidence of record, the examiner opined that it is less likely than not that the Veteran's heart palpitations and hypertension had an in-service onset or are otherwise causally related to the Veteran's military service.

The Board finds that the April 2021 and September 2021 reports have previously been determined to be inadequate for adjudication purposes by way of a September 2024 Board order. The above listed reports were deemed inadequate because the reports did not provide rationale in support of the conclusions.

The VA conducted a review of the evidence of record in September 2023. The examiner considered the Veteran's in-service toxic exposures and opined that it is less likely than not that the Veteran's hypertensive cardiovascular condition was caused by the Veteran's toxic exposures considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic combined effect of all toxic exposure risk activities of the Veteran. The examiner found that the Veteran was not diagnosed with hypertension until 14 years post service and there is no indication that he had high blood pressure prior his initial diagnosis. The examiner further indicated that the Veteran had several risk factors for developing hypertension including the use of tobacco for 10 years, the use of alcohol, obesity, and a family history of hypertension.

The VA conducted a review of the evidence of record in December 2024. The examiner diagnosed the Veteran with hypertension and heart palpitations. The examiner indicated that the Veteran's heart conditions are first noted in private treatment records from November 2009. The examiner found that there is no evidence of in-service treatment or complaints of heart palpitations or hypertension and no history of cardiovascular issues in-service or immediately after service. Considering these facts, the examiner opined that it is less likely than not that the Veteran's cardiovascular conditions were incurred in or caused by the Veteran's military service. The examiner also found that it is less likely than not that the cardiovascular conditions were caused by the Veteran's in-service toxic exposures considering the total potential exposure through all military deployments of the Veteran and the combined synergistic effect of all toxic exposure risk activities of the Veteran. The examiner indicated that he could not find any medical literature or other evidence which supports a correlation between the Veteran's heart palpitations and his in-service toxic exposures.

The Appellant has not provided a medical report or any other competent evidence indicating that the Veteran's cardiovascular disorder manifested by heart palpitations and hypertensive heart disease is related to his active duty military service
it is less likely than not that the Veteran's cardiovascular conditions were incurred in or caused by the Veteran's military service. The examiner also found that it is less likely than not that the cardiovascular conditions were caused by the Veteran's in-service toxic exposures considering the total potential exposure through all military deployments of the Veteran and the combined synergistic effect of all toxic exposure risk activities of the Veteran. The examiner indicated that he could not find any medical literature or other evidence which supports a correlation between the Veteran's heart palpitations and his in-service toxic exposures.

The Appellant has not provided a medical report or any other competent evidence indicating that the Veteran's cardiovascular disorder manifested by heart palpitations and hypertensive heart disease is related to his active duty military service. The Board acknowledges the Appellant's contentions, the numerous buddy statements filed in support of the Veteran, and the late Veteran's statements indicating that his heart palpitations are related to his military service. The Board acknowledges that the Veteran was competent to report his symptoms and on matters of which he had personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, there is no evidence that the Veteran in this case was competent to provide a nexus opinion regarding this issue as this issue is medically complex and the record does not show that the Veteran had the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).

Considering the foregoing, the evidence persuasively weighs against the claim. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). The benefit of the doubt doctrine, see 38 U.S.C. § 5107 (b), is therefore not applicable to this claim. Accordingly, service connection for cardiovascular disorder manifested by heart palpitations and hypertensive heart disease is denied.

4. Entitlement to service connection for a liver condition manifested by elevated liver enzymes and NAFLD is denied.

The Appellant contends that the Veteran's liver condition manifested by elevated liver enzymes and NAFLD is causally related to his active duty military service. Having carefully considered the evidence of record, and considering all relevant rules and regulations, the Board finds that the Veteran's contention is not warranted.

Initially, a June 2019 VA examiner diagnosed the Veteran with a liver condition manifested by elevated liver enzymes and NAFLD. Further, the Veteran submitted an October 2014 VA Form 9 in which he alleged that his elevated liver enzymes began when he participated in Operation Desert Storm. Considering this evidence in a light most favorable to the Veteran, the Board finds that the first two elements of service connection have been satisfied. The remaining issued to be decided is whether the Veteran's liver condition manifested by elevated liver enzymes and NAFLD was incurred in or is otherwise causally related to his military service.

The Veteran filed a VA Form 9 Notice of Disagreement in October 2014. On that form, the Veteran indicated that he believes that his elevated liver enzymes are related to his military service and participation in Operation Desert Storm. The Veteran stated that he feels like he was poisoned by the Gulf War.

The Veteran was afforded a VA examination in March 2014. The examiner found that testing showed no evidence of a current liver disorder and there was no evidence that the Veteran had been diagnosed with a liver condition during service. Upon testing, the examiner found that the Veteran's liver enzymes were normal.

The Veteran attended a VA examination in June 2019. The examiner diagnosed the Veteran as suffering from NAFLD. The examiner took a history of the Veteran's liver condition beginning in 2006, approximately 10 years post service. The examiner concluded that it is less likely than not that the Veteran's liver condition manifested by elevated liver enzymes and NAFLD had an in-service onset or is otherwise related to the Veteran's military service to include service in the Persian Gulf. The examiner found no service treatment records or any other evidence documenting liver symptoms in-service or immediately post service. Accordingly, the examiner found that is less likely than not that the Veteran's liver condition manifested by elevated liver enzymes and NAFLD is related to his military service.

The Veteran was
onset or is otherwise related to the Veteran's military service to include service in the Persian Gulf. The examiner found no service treatment records or any other evidence documenting liver symptoms in-service or immediately post service. Accordingly, the examiner found that is less likely than not that the Veteran's liver condition manifested by elevated liver enzymes and NAFLD is related to his military service.

The Veteran was afforded a VA examination in April 2021. Addendums to this report were authored in September 2021 and December 2021. The VA requested addendum opinions to the April 2021 and September 2021 reports because these reports were based on incorrect criteria. Ultimately, in the December 2021 addendum, the examiner opined that there is no diagnosed liver condition, just elevated enzyme levels. Accordingly, the examiner opined that it is less likely than not that the Veteran's liver disorder was incurred in or caused by his military service.

The Appellant has not provided a medical report or any other competent evidence indicating that the Veteran's liver condition manifested by elevated liver enzymes and NAFLD is related to his active duty military service. The Board acknowledges the Appellant's contentions, the numerous buddy statements filed in support of the Veteran, and the late Veteran's statements indicating that his liver condition manifested by elevated liver enzymes and NAFLD is related to his military service. The Board acknowledges that the Veteran was competent to report his symptoms and on matters of which he had personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, there is no evidence that the Veteran in this case was competent to provide a nexus opinion regarding this issue as this issue is medically complex and the record does not show that the Veteran had the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).

Considering the foregoing, the evidence persuasively weighs against the claim. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). The benefit of the doubt doctrine, see 38 U.S.C. § 5107 (b), is therefore not applicable to this claim. Accordingly, service connection for liver condition manifested by elevated liver enzymes and NAFLD is denied.

5. Entitlement to service connection for degenerative joint disease of the cervical spine is denied.

The Appellant contends that the Veteran's degenerative joint disease cervical spine is causally related to his active duty military service. Having carefully considered the evidence of record, and considering all relevant rules and regulations, the Board finds that service connection for degenerative joint disease cervical spine is not warranted.

Initially, a November 2011 rating decision confirmed that the Veteran had been diagnosed with degenerative joint disease cervical spine. Further, the Veteran submitted a July 2010 Statement in Support of Claim in which he alleged that his cervical disability began while he participated in Operation Desert Storm. Therefore, the Board finds that the first two elements of service connection have been satisfied. The remaining issued to be decided is whether the Veteran's degenerative joint disease cervical spine was incurred in or is otherwise causally related to his military service.

The Veteran submitted a July 2010 Statement in Support of Claim. The Veteran stated that he developed cervical problems while driving a tractor trailer in the desert while serving in Operation Desert Storm. The Veteran indicated that he did not report his symptoms at that time and he just "sucked it up".

The Veteran filed a VA Form 9 Notice of Disagreement in October 2014. On that form, the Veteran indicated that he believes that his cervical disability is related to his military service and participation in Operation Desert Storm. The Veteran stated that he feels like he was poisoned by the Gulf War.

The Veteran was afforded a VA examination in March 2014. The examiner diagnosed the Veteran as suffering from a cervical strain and degenerative arthritis of the spine. The physician ultimately opined that he could not relate the Veteran's current cervical disability to his active duty without resorting to medical speculation. In his report, the examiner indicated that the Veteran's active duty treatment records could not be located.

The Veteran attended a VA examination in
VA Form 9 Notice of Disagreement in October 2014. On that form, the Veteran indicated that he believes that his cervical disability is related to his military service and participation in Operation Desert Storm. The Veteran stated that he feels like he was poisoned by the Gulf War.

The Veteran attended a VA examination in June 2019. The examiner diagnosed the Veteran as suffering from a cervical strain. The examiner took a history of the Veteran's cervical condition beginning in-service while the Veteran was driving a truck without a trailer in the desert. The Veteran reported going on sick call for his neck and shoulders while stationed overseas on several occasions. Ultimately, the examiner concluded that it is less likely than not that the Veteran's cervical strain had an in-service onset or is otherwise related to the Veteran's military service to include service in the Persian Gulf. The examiner found no service treatment records or any other evidence documenting cervical pain or symptoms in-service or immediately post service. The examiner found that the first documented treatment for a cervical condition occurred in 1998.

The Board finds that the June 2019 report has previously been determined to be inadequate for adjudication purposes by way of a July 2020 Board order. The June 2019 report was deemed inadequate because the report did not consider all lay evidence of record and all necessary treatment records were not available for review at the time of the June 2019 examination.

The Veteran was afforded a VA examination in April 2021. An addendum to this report was authored in September 2021. The examiner diagnosed the Veteran as suffering from a cervical strain and degenerative joint disease of the cervical spine. Ultimately, the examiner opined that it is less likely than not that the Veteran's cervical strain and cervical degenerative disc disease arose in or were caused by the Veteran's military service.

The VA conducted a review of the evidence of record in September 2023. The examiner considered the Veteran's in-service toxic exposures and opined that it is less likely than not that the Veteran's degenerative joint disease of the cervical spine was caused by the Veteran's toxic exposures considering the total potential exposure through all applicable deployments of the Veteran and the synergistic, combined effect of the Veteran's toxic exposure risk activities. The examiner found that there is no evidence showing that the Veteran's toxic exposures are a cause for the development of degenerative joint disease of the cervical spine.

The Board finds that the April 2021and September 2021 reports have previously been determined to be inadequate for adjudication purposes by way of a September 2024 Board order. The above listed reports were deemed inadequate because the reports did not provide rationale in support of the conclusions.

The VA conducted a review of the evidence of record in December 2024. The examiner confirmed the diagnoses cervical strain and degenerative joint disease of the cervical spine. The examiner ultimately opined that it is less likely than not the Veteran's cervical strain was incurred in or caused by the Veteran's military service. The examiner indicated that he did not find any complaints of, or treatment for, a cervical condition in the Veteran's service treatment records or immediately post service. Accordingly, the examiner indicated that he could not relate the Veteran's cervical condition to his military service.

The Appellant has not provided a medical report or any other competent evidence indicating that the Veteran's degenerative joint disease cervical spine is related to his active duty military service. The Board acknowledges the Appellant's contentions, the numerous buddy statements filed in support of the Veteran, and the late Veteran's statements indicating that his degenerative joint disease cervical spine is related to his military service. The Board acknowledges that the Veteran was competent to report his symptoms and on matters of which he had personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, there is no evidence that the Veteran in this case was competent to provide a nexus opinion regarding this issue as this issue is medically complex and the record does not show that the Veteran had the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).

Considering the foregoing, the evidence persuasively weighs against the
symptoms and on matters of which he had personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, there is no evidence that the Veteran in this case was competent to provide a nexus opinion regarding this issue as this issue is medically complex and the record does not show that the Veteran had the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).

Considering the foregoing, the evidence persuasively weighs against the claim. Lynch v. McDonough, 21 F.4th 776, 781-82 (Fed. Cir. 2021). The benefit of the doubt doctrine, see 38 U.S.C. § 5107 (b), is therefore not applicable to this claim. Accordingly, service connection for degenerative joint disease cervical spine is denied.

6. Entitlement to service connection for OSA is denied.

The Appellant contends that the Veteran's OSA is causally related to his active duty military service. Having carefully considered the evidence of record, and considering all relevant rules and regulations, the Board finds that the Appellant's contention is not warranted.

Initially, a November 2011 rating decision confirmed that the Veteran had been diagnosed with OSA. Further, the Veteran submitted a July 2010 Statement in Support of Claim in which he alleged that his OSA began while he participated in Operation Desert Storm. Therefore, the Board finds that the first two elements of service connection have been satisfied. The remaining issued to be decided is whether the Veteran's OSA was incurred in or is otherwise causally related to his military service.

The Veteran submitted a July 2010 Statement in Support of Claim. The Veteran stated that he developed OSA while serving in Operation Desert Storm. The Veteran indicated that he did not report his symptoms at that time and he just "sucked it up".

The Veteran filed a VA Form 9 Notice of Disagreement in October 2014. On that form, the Veteran indicated that he believes that his OSA is related to his military service and participation in Operation Desert Storm. The Veteran stated that he feels like he was poisoned by the Gulf War.

The Veteran attended a VA examination is June 2019. The examiner acknowledged the diagnosis OSA. The examiner concluded that it is less likely than not that the Veteran's OSA was incurred in or caused by his military service. The examiner found that there is no mention of OSA or a sleep disability until 2009. The examiner further opined that it is less likely than not that the Veteran's OSA is etiologically related to his in-service toxic exposures. The examiner found that medical literature revealed that there was no increased risk for developing OSA for Veteran's who served in the Gulf War.

The Veteran was afforded a VA examination in April 2021. An addendum to this report was authored in September 2021. The examiner ultimately opined that it is less likely than not that the Veteran's OSA had an in-service onset or was otherwise related to the Veteran's military service.

The VA conducted a review of the evidence of record in September 2023. The examiner considered the Veteran's in-service toxic exposures and concluded that it is less likely than not that the Veteran's OSA was caused by his toxic exposures considering the total potential exposure through all applicable military deployments of the Veteran and the combined synergistic effect of all toxic exposure risk activities of the Veteran. The examiner did not opine as to whether the Veteran's OSA is causally related to his military service on a direct causation basis.

The VA conducted a review of the evidence of record in December 2024. The examiner confirmed the diagnosis OSA. Ultimately, the examiner opined that it is less likely than not that the Veteran's OSA was incurred in or caused by his military service. The examiner found that there are no service treatment records documenting in-service sleep problems. Further, there are no post-service treatment records documenting treatment for sleep disturbances in the period immediately following the Veteran's separation from service. Accordingly, the examiner found that no chronic or permanent residual disability has been established. The examiner acknowledged the Veteran's multiple contentions that his OSA arose in-service, including his July 2010 statement, the October 2014 VA Form 9, and the history the Veteran provided at the April 2021 VA examination. However, the examiner found that OSA was not diagnosed until 2019, more than 20 years post service. As such, the examiner opined against service-connection for OSA. The examiner additionally considered the Veteran's conceded in-service toxic exposures and opined that it is less likely than not that the Veteran's OSA was caused by the Veteran's in-service toxic exposures considering the total potential exposure through all applicable military deployments of the Veteran and the synergistic, combined effect of all toxic exposure risk activities of the Veteran. The examiner cited to risk factors apart from the Veteran's toxic exposures as a more likely cause of the Veteran's OSA. Among the risk factors identified by the examiner were a history of smoking, obesity, being 55 years old, and a small oropharynx.

The Appellant has not provided a medical report or any other competent evidence indicating that the Veteran's OSA is related to his active duty military service. The Board acknowledges the Appellant's contentions, the numerous buddy statements filed in support of the Veteran, and the late Veteran's statements indicating that his OSA is related to his military service. The Board acknowledges that the Veteran was competent to report his symptoms and on matters of which he had personal knowledge. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, there is no evidence that the Veteran in this case was competent to provide a nexus opinion regarding this issue as this issue is medically complex and the record does not show that the Veteran had the medical training or credentials to make such a determination. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); see also Kahana v. Shinseki, 24. Vet. App. 428 (2011).

B. MULLINS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board Litts, Norman W. Jr

The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.

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